He experienced it repeatedly: The 911 operators dispatched police, who often took him to a hospital or jail. “They don’t know how to handle people like me,” said White, who struggles with depression and schizophrenia. “They just don’t. They’re just guessing.”
In most of those instances, he said, what he really needed was someone to help him calm down and find follow-up care.
That’s now an option, thanks to a crisis response team serving his area. Instead of calling 911, he can contact a state-run hotline and request a visit from mental health professionals.
The teams are dispatched by a program that serves 18 mostly rural counties in central and northern Iowa. White, 55, has received assistance from the crisis team several times in recent years, even after heart problems forced him to move into a nursing home. The service costs him nothing. The team’s goal is to stabilize people at home, instead of admitting them to a crowded psychiatric unit or jailing them for behaviors stemming from mental illness.
For years, many cities have sent social workers, medics, trained outreach workers, or mental health professionals to calls that previously were handled by police officers. And the approach gained traction amid concerns about police brutality cases. Proponents say such programs save money and lives.
But crisis response teams have been slower to catch on in rural areas even though mental illness is just as prevalent there. That’s partly because those areas are bigger and have fewer mental health professionals than cities do, said Hannah Wesolowski, chief advocacy officer for the National Alliance on Mental Illness.
“It certainly has been a harder hill to climb,” she said.
Melissa Reuland, a University of Chicago Health Lab researcher who studies the intersection of law enforcement and mental health, said that solid statistics are not available but that small police departments and sheriffs’ offices seem increasingly open to finding alternatives to a standard law enforcement response. Those can include training officers to handle crises better or seeking assistance from mental health professionals, she said.
The shortage of mental health services will continue to be a hurdle in rural areas, she said: “If it was easy, people would have fixed it.”
Still, the crisis response approach is making inroads, program by program.
White has lived most of his life in small Iowa cities surrounded by rural areas. He’s glad to see mental health care efforts strengthened beyond urban areas. “We out here get forgotten — and out here is where we need help the most,” he said.
Some crisis teams, like the one that helps White, can respond on their own, while others are paired with police officers or sheriffs’ deputies. For example, a South Dakota program, Virtual Crisis Care, equips law enforcement officers with iPads. The officers can use the tablets to set up video chats between people in crisis and counselors from a telehealth company. That isn’t ideal, Wesolowski said, but it’s better than having police officers or sheriffs’ deputies try to handle such situations on their own.
The counselors help people in mental health crises calm down and then discuss what they need. If it’s safe for them to remain at home, the counselor calls a mental health center, which later contacts the people to see whether they’re interested in treatment.
But sometimes the counselors determine people are a danger to themselves or others. If so, the counselors recommend that officers take them to an emergency room or jail for evaluation.
In the past, sheriffs’ deputies had to make that decision on their own. They tended to be cautious, temporarily removing people from their homes to ensure they were safe, said Zach Angerhofer, a deputy in South Dakota’s Roberts County, which has about 10,000 residents.
Detaining people can be traumatic for them and expensive for authorities.
Deputies often must spend hours filling out paperwork and shuttling people between the ER, jail, and psychiatric hospitals. That can be particularly burdensome during hours when a rural county has few deputies on duty.
The Virtual Crisis Care program helps avoid that situation. Nearly 80% of people who complete its video assessment wind up staying at home, according to a recent state study.
Angerhofer said no one has declined to use the telehealth program when he has offered it. Unless he sees an immediate safety concern, he offers people privacy by leaving them alone in their home or letting them sit by themselves in his squad car while they speak to a counselor. “From what I’ve seen, they are a totally different person after the tablet has been deployed,” he said, noting that participants appear relieved afterward.
The South Dakota Department of Social Services funds the Virtual Crisis Care program, which received startup money and design help from the Leona M. and Harry B. Helmsley Charitable Trust. (The Helmsley Charitable Trust also contributes to KHN.)
In Iowa, the program that helps White always has six pairs of mental health workers on call, said Monica Van Horn, who helps run the state-funded program through the Eyerly Ball mental health nonprofit. They are dispatched via the statewide crisis line or the new national 988 mental health crisis line.
In most cases, the Eyerly Ball crisis teams respond in their own cars, without police. The low-key approach can benefit clients, especially if they live in small towns where everyone seems to know each other, Van Horn said. “You don’t necessarily want everyone knowing your business — and if a police car shows up in front of your house, everybody and their dog is going to know about it within an hour,” she said.
Van Horn said the program averages between 90 and 100 calls per month. The callers’ problems often include anxiety or depression, and they are sometimes suicidal. Other people call because children or family members need help.
Alex Leffler is a mobile crisis responder in the Eyerly Ball program. She previously worked as a “behavior interventionist” in schools, went back to college, and is close to earning a master’s degree in mental health counseling. She said that as a crisis responder, she has met people in homes, workplaces, and even at a grocery store. “We respond to just about any place,” she said. “You just can make a better connection in person.”
Thomas Dee, a Stanford University economist and education professor, said such programs can garner support from across the political spectrum. “Whether someone is ‘defund the police’ or ‘back the blue,’ they can find something to like in these types of first-responder reforms,” he said.
Critics of police have called for more use of unarmed mental health experts to defuse tense situations before they turn deadly, while law enforcement leaders who support such programs say they can give officers more time to respond to serious crimes. And government officials say the programs can reduce costly hospitalizations and jail stays.
Dee studied the Denver Support Team Assisted Response program, which lets 911 dispatchers send medics and behavioral health experts instead of police to certain calls. He found the program saved money, reduced low-level crime, and did not lead to more serious crimes.
Dr. Margie Balfour is an associate professor of psychiatry at the University of Arizona and an administrator for Connections Health Solutions, an Arizona agency that provides crisis services. She said now is a good time for rural areas to start or improve such services. The federal government has been offering more money for the efforts, including through pandemic response funding, she said. It also recently launched the 988 crisis line, whose operators can help coordinate such services, she noted.
Balfour said the current national focus on the criminal justice system has brought more attention to how it responds to people with mental health needs. “There’s a lot of things to disagree on still with police reform,” she said. “But one thing that everybody agrees on is that law enforcement doesn’t need to be the default first responder for mental health.”
Arizona has crisis response teams available throughout the state, including in very rural regions, because settlement of a 1980s class-action lawsuit required better options for people with mental illnesses, Balfour said.
Such programs can be done outside cities with creativity and flexibility, she said. Crisis response teams should be considered just as vital as ambulance services, Balfour said, noting that no one expects police to respond in other medical emergencies, such as when someone has a heart attack or stroke.
“People with mental health concerns deserve a health response,” she said. “It’s worth it to try to figure out how to get that to the population.”
This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.
Below is a true story. All of the names have been changed.
My work day started as I began to listen to my boss’s recording. I took dictation and the earplugs were all set to go. I turned on the machine and heard “Joe” say, “Take a letter. B I N G O.” I took out the earplugs and quietly laughed. Joe was always very serious and professional, especially with any recordings he made. Intrigued, I listened further. I could hear his children in the background as he continued to record nonsensical information, which was not the norm. I put the dictation aside and discovered a little later that Joe was walking towards me with an empty glass. He had an entourage. He said, “Get me water from the good fountain.” I looked at the assistant seated next to me and said, “The good fountain? Is there something I need to know?” As the day unfolded, I learned that Joe was having a nervous breakdown. He was whisked away to a nearby mental facility where he stayed for three weeks. The firm I worked for in the 90s had 4 floors filled with the brightest and smartest attorneys. They were mostly white conservative males. Joe was no exception. He had always been kind and professional to the staff and his colleagues. He had an excellent reputation, and it was an honor to work for him. I talked with Joe’s wife who sounded like she was trying to keep herself together while caring for Joe. I walked around the hallway and heard one of his younger colleagues shout into the phone, “They just took Joe to the mental hospital!” I closed “Sean’s” door. I did not close it gently. Joe deserved the respect that he had always shown others. He stayed at the hospital and received the help he needed. I learned he was bipolar. The first day he came back to work, he looked a bit like a fish out of water. As the days and months went on, Joe conquered any stigmas that mental illness may have had. As the years went on, he became managing partner of the very large, very successful law firm. He could have given up, but he chose to move forward. In doing so, he helped all of us follow his lead.
“Joe” died a few years ago from cancer.
This is my job now. It is a full time responsibility. I sleep well, but when I awake at 6:00, the first thing I think of is my mother’s story.
More of her story will follow and will be compiled by her storyteller, me. It is a story I must tell because her story will affect you one day, and you will possibly not even realize it. I write for my mother and father. I write for my family. I write for your family. Heck, I even write for our government officials who make important decisions that will affect your pocket book. I write for the thousands that will try to rebuild their lives after Harvey has taken everything from them.
It happened on a Memorial Day weekend in Georgetown, Texas. I was vacationing with my husband. We had fun things planned. My mother lived in a small group home in Round Rock, just a few miles from Georgetown. She had fallen, which happens as some of us age. I visited her in the hospital. On my way out, I spoke to the neatly dressed nurse and thought I would double check on my mother’s medication.
“She is on her medication, right?” I asked.
The nurse looked a bit confused, but she tried to hide it. After all, none of this story is her fault.
“She is on her anti-psychotic medications?” I asked again, assuming the answer would be in the affirmative.
“I don’t see anything like that on her chart,” she said with a look of confusion.
“We need to contact the doctor right away,” I said firmly. “She NEEDS her medication. If she doesn’t get her medication, you will have a problem on your hands,” I tried to emphasize as politely as possible.
“Okay, we’ll contact her doctor, but he is on vacation.”
I assumed the hospital, the doctors and the nurses would work in tandem regarding the stelazine and other drugs my mother had to take. I checked with the woman who oversaw the group home.
“The doctor is out of town, and Mother is off her medication.”
Sheri’s eyes widened. “I gave them the list of medications,” she said emphatically.
We both knew a tsunami would hit if my mother was not kept on her prescribed anti-psychotic medication.
I struggled to have a good time with my husband on our short trip to Austin. My mind was elsewhere. It was on my mother who suffered from paranoid schizophrenia since she was in her 20s. Paranoid schizophrenia is a horrible disease. We try not to discuss it in polite society. “Break the stigma,” some mental health advocates say. I wish they would come up with a new slogan. BREAK THE DISEASE is what I would like to do. Find a cure is what needs to be cried from the rooftops.
Three words: FIND A CURE!!!!
Another few words: There is a mental health crisis in America! Most people don’t even know it. Most people will be affected by it and pass it every day on the way to work. The dirty, homeless man wandering the streets of downtown alone, the families torn apart because they can’t find help for their mentally ill loved ones who refuse care because of their mental illness. The overcrowded jails, the tax dollars spent on band aids to fix a much larger problem than any of them realize, are all symptoms.
Four words: It is a travesty.
On our way back home to Dallas, we stopped by the hospital to check on my mother. As soon as I stood at the entrance to the unit, I could hear her screaming. The nurse I had spoken to only days before was running back and forth from my mother’s room to me.
“What do you do when this happens?” she frantically asked me.
My heart sank. Mother had been off her medication for three days. It was evident.
As I listened to her loud, persistent cries, I knew there was no way I could help her. There was no way for the nurse to help her.
What do I do when this happens?
“I don’t know what they do! I can’t do a damn thing! She has to go to the psych hospital when this happens!!” I said stunned that this horrible situation had happened and could have been prevented had the doctor returned the phone calls that the nurses made, but he was on vacation.
That simple event of the lack of necessary medications caused a spiral effect. Mother, of course, continued to spiral down due to more delusions, paranoia and hallucinations. No talk therapy could have helped her at this moment. No amount of prayer was going to cure my mother from the severe anxiety she was going through.
Nothing but medication was going to help my mother. Not only did my mother have to suffer, but so did the hospital staff as they desperately tried to ease her pain. It took valuable resources that could have been used on people who were physically ill. It caused distress on other patients who had to hear my mother’s screams. It caused her family anxiety and depression because there was absolutely nothing that could be done. Nothing! As I bang my computer keys to relive this story and its pain, I don’t care that my apartment is a mess or that I desperately need to bathe and comb my hair. I don’t care about me at all in this moment because I don’t tell my mother’s story lightly. There are repeated events in my childhood and adult years that distressed me, but this story is not about me! It’s about you.! It’s about your neighbor and your family. It’s about your community and the first responders, the homeless who will be walking aimlessly down the street looking for anything to pacify the hallucinations, the people who will end up in jail chained to their bed because all they needed was their medication.
I worry and pray for everyone involved with Hurricane Harvey, but I mostly worry about the mentally ill patients and society’s misunderstandings about the importance of their medication. There are many who will need their medications immediately to survive, but there is also an IMMEDIATE need for the government officials to address those who need their medications to stay sane.
As you pray for the flood victims, please say a special prayer for the mentally ill. I suspect there are some that have lost their medication and will have difficulty getting back on it. This can be a game changer for them and their loved ones. It can also be a game changer in the shelters if they have numerous mentally ill patients in desperate need of seeing a psychiatrist for anxiety, depression, hallucinations, trauma…. There is a shortage of psychiatrists in our country. I just hope some of them will be available at the shelters to write prescriptions that have been lost in the flood. If not, the situation will become worse. My prayer and hope is that the government officials are considering this piece of the puzzle as they try to put communities and people back together again.
It is not a topic that you’ll see on the news, yet it is the first thing I think of when I hear about the flood that has taken so many things from people.
It won’t be pretty if it is not addressed. Mental illness is not a respecter of persons. It can affect the rich and the poor, your neighbor and even your family.